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A Comparison of Speech Outcomes Using Radical Intravelar Veloplasty or Furlow Palatoplasty for the Treatment of Velopharyngeal Insufficiency Associated with Occult Submucous Cleft Palate

Paul N. Afrooz, MD, Zoe M. MacIsaac, MD, S. Alex Rottgers, MD, Lorelei J. Grunwaldt, MD, Anand R. Kumar, MD
Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center
2012-02-12

Presenter: Paul N. Afrooz, MD

Affidavit:
The material proposed in this presentation represents 100% of the resident's original work.

Director Name: Joseph E. Losee

Author Category: Chief Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial

How does this presentation meet the established conference educational objectives?
The audience will compare the safety and efficacy of FP versus IVV for treatment of VPI associated with OSMCP.

How will your presentation be used by practicing physicians in the audience?
Practicing physicians will be able to compare outcomes of two different surgical strategies for the treatment of VPI.

Safety, efficacy, and comparison of surgical treatments for velophyarngeal insufficiency associated with occult submucous cleft are poorly characterized. Aims of this study are to report and analyze the safety and efficacy of Furlow Palatoplasy versus Radical Intravelar Veloplasty for treatment of velopharyngeal insufficiency associated with occult submucous cleft palate.

A retrospective review of one institution's experience treating VPI associated with OSMCP using IVV (Group 1) or FP (Group 2) over 24 months was performed. Statistical significance was determined by Wilcoxon matched-pair and ANOVA (SPSS 18.0.0).

Group 1, IVV, 13 patients were identified from 2010-2011 (average age 5.71 years). Four were syndromic and 9 were non-syndromic. In Group 2, FP, 12 patients were identified from 2009-2011 (average age 9.48 years). Two patients were syndromic and 10 patients were non-syndromic. There was no statistical significance between average pretreatment Pittsburgh Weighted Speech Score between groups (Group 1 and 2 averages 11.75 and 18.53 respectively, p=0.055), nor was there statistical significance postoperatively (Group 1 and 2 averages 5.33 and 4.85 respectively, p=0.655). Average operative time was greater for FP (143 minutes, range 93-177) compared to IVV (89 minutes, range 58-108), p<0.001.

Non-syndromic patients with nasal speech are treated effectively with either IVV or FP. IVV tended to lower speech scores more effectively than FP (83% IVV, 57% FP absolute reduction). Syndromic patients with OSMCP may be more effectively treated with FP (51% IVV vs. 71% FP absolute reduction). Both techniques are associated with low morbidity, improved speech scores, and low re-operative rates.

Author Contact Information:
Paul Afrooz
6th floor Scaife Hall
3550 Terrace Street
Pittsburgh, PA
15261

312 9335390
412 3839053 (fax)

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